Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy [post]

Francesca Bravi, Andrea Strada, Niccolò Bolognesi, Lamberto Manzoli, Giorgia Valpiani, Chiara Morotti, Roberto Bentivegna, Elena Forini, Antonella Pesci, Armando Stefanati, Eugenio Di Ruscio, Tiziano Carradori
2020 unpublished
Background : Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called "diagnostic anticipation", which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic
more » ... a diagnostic algorithm approved by physicians. Methods : In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the diagnostic anticipation protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. Using ED electronic data, LOS independent predictors were evaluated through multiple regression. Results : During the weeks when diagnostic anticipation was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 minutes for chest pain, but longer by 15.7 minutes for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority and ED crowding, the difference in visit time was significant for chest pain only (p<0.001). Conclusions : The effectiveness of the anticipation of blood testing by nurses varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status
doi:10.21203/rs.3.rs-20219/v1 fatcat:ghstzm5hsvfizmxr2evfg47kcq